Magnetic resonance imaging (MR) of the prostate is an important part of the diagnostic pathway for patients with suspected prostate cancer. Current practice in many Irish centres is to perform biparametric MRI (bpMRI) incorporating T2- and diffusion-weighted imaging, and interpret it using the latest version of the American College of Radiology Prostate Imaging Reporting and Data System (PI-RADS), version 2.1. No study has yet reported on the use of bp-MRI and PI-RADS 2.1 in the investigation of prostate cancer investigation in the Irish healthcare setting. We aimed to review one year of practice at our regional tertiary prostate cancer referral centre and compare diagnostic yield with international standards. We identified all patients who had undergone prostate biopsy at our institution in 2023 and extracted pre-biopsy MRI results for each patient, comparing MRI results with biopsy reports. We identified 328 patients in the study period who underwent prostate biopsy and pre-biopsy MRI. 182 of these had a pathological diagnosis of clinically significant prostate cancer (csPCa), defined as Gleason score of 7 or higher. Of these, 167 (92%) had a PI-RADS score of 3 or above, meaning at least equivocal for the presence of csPCA. Cancer detection rates were 31%, 54% and 96% for PI-RADS three, four and five lesions respectively. We demonstrated a sensitivity of 92% and specificity of 49% for detection of csPCa, closely aligned with international datasets. The use and performance of bpMRI and PI-RADS 2.1 at our Irish tertiary urological centre is in line with international datasets. These have a key role in the diagnostic pathway of prostate cancer in Ireland.
Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence-based care. To identify recurring implementation-related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real-world management. This expert-informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation-related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co-authors. Twenty-six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5-point Likert scale. Median scores were used for relative prioritisation. Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High-impact pitfalls included empirical triple therapy in high-resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow-up domains, highlighting persistent implementation-related barriers throughout the care pathway. Recurring implementation-related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation-focused strategies to improve delivery of care.
Despite promising results of artificial intelligence (AI) in prostate cancer (PCa) detection, its impact on biparametric MRI (bpMRI) interpretation remains uncertain, especially for readers with limited experience. To evaluate the effect of AI software assistance on prostate bpMRI interpretation by readers with different levels of prostate MRI experience. Retrospective. Six hundred and forty-six male patients, including 297 with PCa. 3.0 T; T2-weighted imaging using fast spin echo sequence, diffusion-weighted imaging using single-shot echo-planar imaging. Two experienced readers (8 and 10 years of prostate MRI experience) and two novice-level readers (2 years of general radiology experience; 20-50 prior prostate MRI cases) assessed all examinations twice, without and with AI software (uAI, United Imaging) assistance, in counterbalanced orders with a 4-week washout interval. Lesions were scored using Prostate Imaging Reporting and Data System (PI-RADS) v2.1 at ≥ 3 and ≥ 4 thresholds. Histopathology was the reference standard. The primary analysis defined cancer as International Society of Urological Pathology (ISUP) grade group ≥ 1 (Gleason score ≥ 6); sensitivity analysis defined clinically significant cancer as ISUP grade group ≥ 2. Generalized Estimating Equations were used for clustered data. Receiver operating characteristic (ROC) analysis with the Obuchowski-Rockette model was used to compare the area under the ROC curve (AUC). Cohen's κ assessed inter-reader agreement; two-sided p < 0.05 indicated significance. For ISUP ≥ 1, uAI increased novice-level/experienced-reader AUCs (0.684-0.744; 0.757-0.794). At PI-RADS ≥ 3, novice-level sensitivity/specificity significantly improved (0.71-0.79; 0.46-0.58). Experienced-reader sensitivity gains were nonsignificant (p = 0.344/0.291). For ISUP ≥ 2 at ≥ 3, all-reader sensitivity/specificity increased (0.76-0.82; 0.47-0.57). Novice-level κ increased at ≥ 3/≥ 4 (0.582-0.700; 0.654-0.741). uAI assistance improved diagnostic performance, with multi-metric improvements in novice-level readers. Stage 3. This study tested whether artificial intelligence software could help doctors read prostate MRI scans more consistently and accurately. The researchers studied 646 men with 730 lesions. Two experienced doctors and two doctors with limited prostate MRI experience reviewed each case without and with artificial intelligence support. The software improved several measures of cancer detection, especially for doctors with limited experience, and increased agreement between these doctors. Additional analyses showed that doctors rarely changed correct judgments to match incorrect artificial intelligence outputs, whereas incorrect judgments were more often corrected. These findings support artificial intelligence as a decision‐support tool for prostate MRI.
China's soybean supply is heavily dependent on international markets, making it an urgent task to enhance domestic self-sufficiency to ensure food security. Data from the national soil census indicate that China possesses approximately 500 million mu of saline-alkali soil resources, of which about 200 million mu have potential for agricultural development. Against the backdrop of tight arable land resources, developing new soybean varieties tolerant to saline-alkali conditions represents a strategic initiative to effectively utilize saline-alkali land, expand cultivation areas, and address the challenge of soil salinization. Rapid alkalinization factors (RALFs) are a class of plant small peptides that act as ligands, initiating downstream signaling by binding to plasma membrane receptor complexes, thereby coordinating plant growth, development, and stress responses. However, the specific molecular mechanisms by which RALF peptides mediate responses to saline-alkali stress in important crops such as soybean remain unclear. Through expression profiling analysis of the soybean RALF family, combined with transcriptome data under alkaline salt treatment, this study identified two homologs of Arabidopsis thaliana AtRALF34, designated GmRALF34a and GmRALF34b, which are predominantly expressed in roots and whose expression is significantly suppressed following alkaline salt treatment. Using gene editing technology, we generated Gmralf34ab double mutants, which exhibited enhanced sensitivity to alkaline salt stress. In contrast, no significant differences were observed between the mutant and wild type plants under neutral salt stress. Field phenotypic characterization further demonstrated that the mutants showed significant reductions in agronomic traits, including plant height, node number, and yield per plant. In conclusion, this study preliminarily reveals that GmRALF34s play an important role in soybean response to alkaline salt stress and adaptation to saline-alkaline environments, provides valuable genetic materials for further elucidating their molecular mechanisms and establishing a theoretical and material foundation for breeding salt-alkali tolerant soybean varieties. 我国的大豆(Glycine max)供给严重依赖国际市场，提升国内自给能力已成为保障粮食安全的紧迫任务。全国土壤普查数据显示，我国拥有约5亿亩盐渍土资源，其中约2亿亩具备农业开发潜力。在耕地资源紧张的背景下，培育耐盐碱大豆新品种，是实现盐碱地资源有效利用、扩大种植面积并应对土壤盐渍化挑战的战略性举措。快速碱化因子(rapid alkalinization factor，RALF)是一类作为配体的植物小肽，通过结合质膜受体复合物启动下游信号，协调植物生长发育与逆境响应。然而RALF小肽在大豆等重要作物中介导盐碱胁迫应答的具体分子机制尚不明确。本研究通过对大豆RALF家族进行表达模式分析，并结合碱性盐处理下的转录组数据，发现拟南芥(Arabidopsis thaliana)的AtRALF34在大豆中的两个同源基因GmRALF34a和GmRALF34b在根中优势表达，且其表达在碱性盐处理后受到显著抑制。利用基因编辑技术获得Gmralf34ab双突变体，该突变体表现为对碱性盐胁迫敏感性增强，相比之下，在中性盐胁迫下，突变体与野生型无显著差异。大田表型鉴定进一步表明，突变体在株高、节数和单株产量等农艺性状上均显著降低。综上，本研究初步揭示了GmRALF34s在大豆响应碱性盐胁迫及盐碱地适应性中扮演着重要角色，为深入解析其分子机制提供了重要遗传材料，并为大豆耐盐碱育种奠定了理论与材料基础。.
Autistic children can experience elevated levels of emotional and behavioural problems, which adversely impact their psychosocial functioning. Positive parenting behaviours can significantly shape children's emotional and behavioural developmental trajectories. However, for autistic children, these parenting behaviours may vary depending on their social, sensory and intellectual profiles. Literature on the association between parenting behaviours and autistic children's internalising and externalising symptoms has been mixed. Thus, the main objective of this study will be to conduct a systematic review and meta-analysis of studies evaluating the effect of parenting behaviours on autistic children's internalising and externalising symptoms. Included studies have child samples between ages 6 and 17 years and a primary diagnosis of autism/Autism Spectrum Disorder (ASD), pervasive developmental disorder and/or Asperger's syndrome as well as a measure of parenting behaviour. Primary outcomes are internalising and externalising symptoms. Substantive and methodological moderators will be examined. Searches will be conducted in MEDLINE, PsycINFO, Embase, Education Resources Information Center (ERIC) and ProQuest Dissertations and Theses Global from their inception onwards, and we will also conduct backward/forward searching of eligible studies. Published and unpublished studies will be examined. Two independent reviewers will conduct title/abstract and full-text screening as well as data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Quality Assessment Scale and JBI Critical Appraisal tools. A random-effects meta-analysis model will be used, and summary effect sizes will be calculated. Moderation will be examined via Q-statistics and meta-regression to determine factors contributing to between-study variation in effect sizes. Ethics approval is not required, as this review will use secondary data from published studies. Results will be disseminated through a peer-reviewed publication and conference presentations. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024528043). PROSPERO CRD42024528043.
To enhance the competency of clinical medicine students in evaluating the severity of genetic disorders, this study first modularized an assessment of genetic diseases severity based on the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Then, this modular teaching framework was applied in teaching instruction. During the Medical Genetics course, the 2024 clinical medicine cohort at Hunan University of Medicine were clustered into a experimental group (6 classes, 203 students) and a control group (7 classes, 235 students) randomly. The experimental group engaged in the ICF-based module in the case analysis of genetic diseases, while students in the control group followed the traditional teaching methods. Learning outcomes were evaluated by analyzing the student-written genetic disease severity evaluation reports. Results demonstrated that students in the experimental group achieved significantly higher scores on their assessment reports (73.33±7.16) compared to the control group (64.79±5.45), with a statistically significant difference (t=13.87, P<0.001). Furthermore, textual analysis further revealed that reports from the experimental group contained a significantly higher frequency of keywords related to patient psychology, social functioning, and environmental factors, indicating a broader focus on the patients and more comprehensive and in-depth understanding of the patient's situation. These findings suggest that the ICF-based modular teaching framework significantly improves medical students' ability to conduct individualized assessments of genetic diseases and effectively fosters their humanistic care. This study provides an actionable and scalable teaching practice pathway for cultivating clinical genetic counseling professionals. 为提升临床医学生遗传病严重性的评估能力，本文首先基于世卫组织国际功能、残疾和健康分类(International Classification of Functioning, Disability and Health，ICF)框架，对遗传病严重性评估进行模块化整合，形成评估模型。继而在湖南医药学院2024级临床医学班级中随机抽取班级作为实验组(6个班级，203名学生)和对照组(7个班级，235名学生)，实验组学生在遗传病案例讲解中接受基于ICF框架的遗传学教学，对照组学生采用传统教学方式。通过评估学生撰写的遗传病严重性评估报告来检验学习效果。结果表明，实验组学生评估报告得分(73.33±7.16)显著高于对照组(64.79±5.45)，差异具有统计学意义(t=13.87，P<0.001)，并且实验组学生撰写的报告在结构上更具系统性。此外，实验组学生提及患者心理、社会功能及环境因素等关键词的频次显著高于对照组，表明实验组学生对患者的关注面显著拓宽，对患者处境的理解更为全面和深入。上述结果提示，基于ICF框架的模块化教学整合可显著提升临床医学生对遗传病的个体化评估能力，并有效培养其人文关怀精神。本文为临床遗传咨询人才培养提供了可操作、可推广的教学实践路径。.
Measuring outcomes of treatments that seek to align a person's voice with their gender identity is important for improving gender-affirming care (GAC). The objective of this study was to assess the construct validity of the GENDER-Q Voice Sound and Voice Distress scales. An international field test study of the GENDER-Q was undertaken, which finalized the development of the scales. Participants were 18 years of age or older, and were seeking or had received GAC in the past 5 years, and completed the Voice Sound and Voice Distress scales. Predefined hypotheses of expected group differences and associations with other GENDER-Q scales were tested using independent samples t test, analysis of variance, and Pearson correlation coefficient. Acceptance of at least 75% of hypotheses was considered sufficient evidence of construct validity, as per COnsensus-based Standards for the Selection of Health Measurement InstrumeNts criteria. A total of 5424 participants were included in the analysis with a mean age of 32.8 years (standard deviation = 12.3; range 18-83 years). The sample was comprised of 33.6% men, 36.8% women, 23.8% non-binary, and 5.7% another gender. Voice therapy was undertaken by 21.4% of participants, and 30.5% wanted this therapy. Fewer participants had undergone voice-related surgery (1.7%), with 10% wanting this surgery. Results supported 16 of 18 (89%) hypotheses for the Voice Sound scale, and 18 of 19 (95%) hypotheses for the Voice Distress scale. The GENDER-Q Voice Sound and Voice Distress scales demonstrated construct validity. These scales can be used to assess voice-related outcomes for adults aged 18 years and older who are seeking or receiving gender-affirming voice interventions.
Labral tears are common in young adults participating in high-impact physical activity. No longitudinal studies have investigated whether labral tears expedite cartilage loss. This longitudinal study investigated the association between labral tears and cartilage loss in young adults participating in high-impact physical activity. Study participants were high-impact athletes (soccer or Australian football) with and without hip and/or groin pain from the femoroacetabular impingement and hip osteoarthritis cohort study who underwent unenhanced 3T MRI at baseline and after 2-3 years. Labral tears and cartilage defects were scored semi-quantitatively. At baseline, labral tear presence (grade ≥2), subregion, number of subregions affected by labral tear, maximal labral score, labral sum score and presence of paralabral cysts were determined. A cartilage sum change score (difference between baseline and follow-up) was calculated for each hip (0-20). Negative binomial regression models were used to estimate if baseline labral tears were associated with cartilage loss, adjusting for sex, age, body mass index, alpha angle and baseline cartilage sum score. 173 (343 hips) participants (82% with hip and/or groin pain; 22% women) with a median age of 26 years were included. The median International Hip Outcome Tool-33 total score was 69 at baseline. Follow-up MRIs were collected at a median of 2.1 years after baseline. 150 (87%) participants were still participating in high-impact physical activity at follow-up. Weak-to-moderate strength associations were identified between cartilage sum change score and baseline anterior labral tears (adjusted incidence rate ratio (a)IRR 1.46; 95% CI 1.01 to 2.09), paralabral cysts (aIRR 1.38; 95% CI 1.02 to 1.86) and labral sum score (aIRR 1.05; 95% CI 1.00 to 1.09). Our findings suggest that acetabular labral tears contribute to cartilage loss in young adult athletes; however, the associations observed were modest, suggesting that additional factors contribute to cartilage loss in this population. Further research is required to inform preventative strategies aimed at reducing cartilage loss in athletes with labral tears.
The purpose of this document is to provide a summary of the current expert opinion and recent literature for clinicians, Indigenous health workers and patient advocates interested in Kidney Supportive Care (KSC) in Australia and New Zealand. Our purpose is not to duplicate the recently released International Society of Nephrology (ISN) KSC/Conservative Kidney Management (https://academy.theisn.org/products/kidney-supportive-care-and-conservative-kidney-management-curriculum#tab-product_tab_overview), but to present an Australian and New Zealand perspective on this emerging field. A key focus of this document is to highlight patients' perspectives on this topic. The document refers to adult patients living with advanced kidney disease (Stages IV and V chronic kidney disease).
The Urgent Epileptic Seizures Care Process (UESP), also known as the Seizure Code, is a care process implemented in the Community of Madrid with the objective of standardizing and optimizing the urgent management of epileptic seizures (ESs) in pediatric and adult patients. The aim of this care process, which is based on the recommendations of the national consensus guideline in Spain and international guidelines, is to standardize the diagnosis, treatment, and follow-up of severe ESs across all levels of care. It was developed through a multidisciplinary collaborative effort involving professionals in emergency medicine, intensive care, neurophysiology, pediatric neurology, and primary care, and was structured into twelve sub-processes reviewed and endorsed by Spanish scientific societies. The Seizures Code establishes operational criteria for activation and defines specific algorithms for management in different clinical settings. It includes intervention times, therapeutic sequences with early and systematic use of benzodiazepines and early combination therapy with antiseizure medications, as well as strategies for coordination between care levels. It also promotes early use of electroencephalography (EEG), ongoing training for health care professionals and families, and a standardized registry of care activity. The Seizure Code is the first comprehensive model for urgent management of severe ESs implemented in a Spanish autonomous community. Its design promotes an early, homogeneous, and evidence-based response, with particular impact on the pediatric population. It enhances interhospital coordination and therapeutic adherence and is a dynamic tool that supports continuous evaluation and improvement of care quality in pediatric neurology.
The study compared the clinicopathologic characteristics and prognosis of patients with uterine isthmus cancer to those with uterine fundus cancer. The aim was to identify risk variables associated with the prognosis of patients with isthmus cancer. In the SEER cohort, 584 endometrial cancer patients were included: 91 in the isthmus group and 493 in the fundus group. Data for this retrospective study were collected from the Surveillance, Epidemiology, and End Results (SEER) database and the registry of a provincial hospital. SEER included individuals diagnosed with endometrial cancer between 2000 and 2018. Patients were divided into two groups according to the primary site code for endometrial cancer: Isthmus and fundus. Chi-square tests were used to compare the population characteristics. STROBE Protocol was followed. Isthmus cancers were younger, more advanced, often non-endometrioid adenocarcinomas, and more likely to receive adjuvant therapy (p < 0.05). The 3-year overall survival rate for isthmus cancer was significantly lower than for fundus cancer (p = 0.016). Uterine isthmus cancer in the hospital cohort accounted for 2.0% (9/455) of the diagnosed endometrial cancers. All patients survived without recurrence or metastasis and were in good physical condition. The research assessed the prognostic impact of the uterine isthmus and the clinical and pathological features of uterine isthmus cancer, and the associated risk factors affecting prognosis. Uterine isthmus cancer demonstrates a higher stage, a stronger tendency for adjuvant therapy, and a more unfavorable prognosis when compared to fundus carcinoma. The international evidence is diverse on this issue.
Sex and gender influence how chest pain presents, how it is assessed and its outcomes, yet accelerated diagnostic protocols (ADPs) used in emergency departments (EDs) largely ignore these differences. This systematic review assesses the extent to which sex-based and gender-based factors are addressed in studies implementing ADPs in EDs for adult patients presenting with chest pain. Six electronic databases were searched from inception through 31 May 2024, for ED-based studies on ADP implementation in adults with suspected cardiac chest pain. Eligible study designs included randomised controlled trials, controlled clinical trials, cohort studies, before/after studies and observational studies. Two reviewers independently screened articles for relevance and inclusion, with disagreements resolved by third-party adjudication. The primary outcome was the proportion of studies providing sex-disaggregated or gender-disaggregated analyses for key ED outcomes; secondary outcomes included the accuracy of sex and gender reporting per Canadian Institutes of Health Research definitions. From 19 455 records, 211 studies were included, predominantly prospective cohort designs (39%), with most data collected in ED settings (87%). While 95% reported participant sex, 76% did so appropriately; fewer than 20% considered sex or gender explicitly in their analyses or ADP applications. Gender was reported less frequently (37%) and reporting was largely inaccurate (92%). No studies presented sex-disaggregated or gender-disaggregated analyses for key ED outcomes (eg, length of stay, consultations, admissions, major adverse cardiac events). Regression analyses failed to identify significant increases in sex/gender reporting following major international sex-based and gender-based policy initiatives. Our findings highlight a critical need for improved and consistent integration of sex and gender in ED cardiac research. While most studies recognise the importance of sex differences, few explicitly addressed them, and even fewer considered the complexity of gender identities meaningfully. Future research should examine sex-specific and gender-specific troponin cut points, investigate at-risk groups and report disaggregated analyses of ED-relevant outcomes. CRD42022380813.
Non-specific low back pain (NSLBP) represents about 80-95% of all LBP cases, yet the optimal lumbar traction position for effective treatment remains debated. To investigate the effect of different positions during lumbar traction on pain, function, and ROM in adults with NSLBP. Thirty participants were randomly allocated to one of three lumbar traction position groups: supine, side-lying, or prone. Outcome measures included the Oswestry Disability Index (ODI), International Physical Activity Questionnaire short form (IPAQ-SF), Finger-to-Floor Test (FFT), and Numerical Pain Rating Scale (NPRS). Measurements were obtained at baseline, after the third session, and after completion of the 3-week intervention. Within-group analysis showed significant improvements in ODI and NPRS scores over time in all three groups (p < 0.001). The supine group demonstrated earlier within-group improvement after the third session (p = 0.012). IPAQ improved significantly only in the side-lying group (p = 0.01), whereas FFT did not show significant changes in any group (p > 0.05). However, between-group analysis revealed no statistically significant differences among the three traction positions at any measurement point for any outcome (p > 0.05). Lumbar traction was associated with improvements in pain and disability regardless of position. However, no traction position demonstrated superiority over the others. The earlier improvement observed in the supine group should be interpreted cautiously because it was based on within-group change rather than between-group superiority. Future studies with larger samples are needed to clarify whether positional differences are clinically meaningful. Also, these findings are limited to male participants and should not be generalized to female populations.Trial registration: The trial was registered on 02/02/2025, clinicaltrials.gov, Identifier: (NCT06812338).
Psychiatric nosology serves both clinical and research needs by providing a common language and informing healthcare planning. However, a movement toward transdiagnostic approaches is growing for assessments and care management of neurodevelopment disorders. During childhood and adolescence, symptoms appear as developmental delays. They often overlap across disorders, making the diagnosis difficult. To account for the multidimensional symptomatology, we propose a visualization of neurodevelopmental disorders phenomenology that would make it easier to analyze an individual as a network of diagnostic criteria whose interactions can compensate for each other and determine a pathological, at-risk or healthy impact. Such spatial organization would allow for the diagnostic criteria to be ordered over time, prioritized, and shared more effectively beyond the categorial diagnosis. Symptoms for neurodevelopmental disorders were grouped according to a hierarchy of phenomenological and symptomatological terms found in the main reference manuals and in the didactic consensus reported in the latest international reviews. They fall into four major domains: cognition, emotion, behavior and motricity while the operational diagnostic criteria were organized into a multiscalar hierarchy with a notion of order following a circular tree structure: the 'sunburst'. A graphic, visual, dynamic and hierarchical organization was proposed to handle all the phenomenology terms used in children, adolescents and young adults (aged 5-25) more easily and to convey them to the parties involved. Far from being exhaustive, this visual representation aims to facilitate the use of psychiatric phenomenology while maintaining a critical, dynamic and evolving approach to scientific knowledge and clinical practice.
Inappropriate mechanical ventilation plays a pivotal role in the development of ventilator-induced lung injury (VILI) and subsequent postoperative pulmonary complications (PPCs), thus individualised lung protective ventilation became a hot topic of research during the past decades. Despite promising results from early trials focusing on separated ventilatory parameters, the incidence of PPCs has not decreased significantly, hence a new conceptual direction emerged in the last few years by evaluating the potential role of mechanical power of ventilation (MP), since MP encompasses all mechanical ventilation parameters that can be responsible for lung injury and recent research confirmed correlation between high MP values and the severity of VILI. Reducing MP by optimising positive end-expiratory pressure (PEEP) is rational, and electrical impedance tomography (EIT) appears to be a promising tool in achieving this goal, as it has the potential to distinguish alveolar recruitment from overdistension, thus providing a more accurate picture of the lungs thereby being superior to other approaches. Therefore, it is worth testing this hypothesis in a clinical trial. This multicentric, single-blinded, interventional, superiority, randomised controlled trial will include 200 patients aged 18 years and older undergoing laparoscopic gynaecological surgeries. The trial will be conducted in three Hungarian centres (two non-university teaching hospitals and one university medical centre). Participants will be allocated in a 1:1 ratio to two groups. Patients in the PEEP-EIT group will receive an EIT-guided PEEP titration, while in the PEEP-dynamic pulmonary compliance (Cdyn) group a dynamic pulmonary compliance-guided PEEP titration will be performed in order to determine the optimal level of PEEP. We aim to evaluate the superiority of using EIT-guided PEEP titration versus the Cdyn-guided approach by comparing their effects on MP, as the primary endpoint, measured immediately after the titration procedure and at the end of surgery. Secondary endpoints are oxygenation, respiratory mechanics parameters, global inhomogeneity index, overdistension/collapse and PPCs. Participants will be followed up until the 28th postoperative day for mortality. This study was approved by the Hungarian Scientific and Medical Research Council Ethics Committee (Registration number: NNGYK/21074-6/2025) on 17 June 2025. Written informed consent will be obtained from all participants (or their legally authorised representatives) prior to enrolment in the study. The trial results will be published in a peer-reviewed journal and presented at international conferences. NCT07170514.
Members of the genus Peucedanum (Apiaceae) are used as vegetables or medicinal materials but exhibit high morphological and chemical diversity, complicating their taxonomy. Here, we applied ultra-high-performance liquid chromatography-quadrupole/time-of-flight mass spectrometry and field emission scanning electron microscopy to 24 Korean Peucedanum accessions from eight species, including five endemics. Multivariate analysis separated the genus into three distinct chemotaxonomic groups, supporting recent reclassification trends. P. japonicum, the source of Peucedani Japonici Radix, contained three unique pyranocoumarin derivatives and dense wax deposits, serving as chemotaxonomic biomarkers and distinguishing Sinopeucedanum from Peucedanum. Sillaphyton podagraria (formerly P. insolens) featured two flavonoid glucoside derivatives and hypostomatic, densely striated-surface leaves. Six species contained coumarin glucoside derivatives, supporting segregation of Peucedanum sensu lato to Kitagawia. These findings refine species boundaries and provide new perspectives for future taxonomic studies, while identifying robust chemical markers applicable to food authentication, quality control, and functional food development involving Peucedani Japonici Radix.
The Coherent Backscattering (CBS) peak is a well-known interferential signature of weak localization in disordered or chaotic systems. More recently, a second interference feature-the Coherent Forward Scattering (CFS) peak-was predicted to emerge in the regime of strong localization. However, it has never been directly observed. Here we report the direct observation of the CFS peak and demonstrate its dual role as a signature of non-ergodicity and as a probe of symmetries in quantum chaotic systems. Using a shaken rotor model realized with a Bose-Einstein condensate (BEC) of ultracold atoms in a modulated optical lattice, we investigate dynamical localization in momentum space. The CFS peak emerges in the position distribution as a consequence of non-ergodic dynamics, while its growth timescale and width reveal the underlying localization length. By finely tuning the modulation, we control time-reversal and parity symmetries and measure their distinct effects on both CBS and CFS peaks in position space. Our results highlight the strong link of both temporal growth and contrast of the coherent scattering peaks with symmetry and localization. This work opens several perspectives for investigating coherent scattering signatures in a many-body context.
Winners of aggressive intergroup encounters are often assumed to benefit from increased access to resources, but few studies have measured whether there is differential access to resources based on the intergroup outcome. To investigate whether winning intergroup encounters is associated with increased access to food, we used 13 months of data on intergroup dynamics, feeding by 61 females, and the phenology and spatial distributions of food trees from the home ranges of 8 groups of white-thighed black-and-white colobus (Colobus vellerosus) at Boabeng-Fiema, Ghana. Contested trees were important food species more often than expected based on the occurrence of these species in the study area. Contested trees had young leaves, fruits, and seeds more often than expected based on the presence of these plant parts on trees monitored via monthly phenology surveys. Focal females were more likely to feed on the contested tree than other trees they were in during and immediately after the intergroup encounter. Based on group scan data collected throughout the day of an intergroup encounter, the likelihood of females feeding on any food species before and during the intergroup encounter was similar regardless of the outcome. The likelihood of feeding was higher after the intergroup encounter if the group had won compared to if the group had lost. These findings indicate that groups compete over access to important food resources and winners benefit from increased access to food. Future studies should investigate whether winning intergroup encounters is associated with long-term benefits such as increased reproductive success.
With over 4 billion people using social media platforms daily, decisions about what content to allow or moderate have profound implications for global public discourse, democratic deliberation, and users' psychological well-being. This study examines cross-national variation in content moderation preferences by exposing participants in 10 countries to a standardized example of hate speech: a hateful post modeled on text that X (formerly Twitter) had cited in its content moderation guidelines. Across contexts, exposure to such content triggers widespread support for intervention, with minimal differences based on the experimentally varied identity of the target. However, significant variation emerges across countries. The United States stands out for its comparatively lower support for moderation of hate speech, while countries like France, Brazil, and South Africa exhibit much stronger demand. Within most countries, political ideology predicts support: individuals on the right are less likely to endorse removal or suspension than those on the left. Crucially, values around freedom of speech versus harm prevention consistently shape preferences across all contexts. Those who prioritize prevention from harm are markedly more likely to support hard forms of moderation (e.g., account suspension and content take-downs). These findings highlight that moderation preferences are shaped less by the specific target than by individuals' deeper commitments regarding free expression and harm prevention.
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